Government’s spending plans for NHS and social care in England
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2837 (Published 24 November 2022) Cite this as: BMJ 2022;379:o2837
The UK’s new chancellor, Jeremy Hunt, set out the government’s latest plans for tax and spending in the autumn statement on 17 November.1 UK public finances are being hit by weak growth—the economy is now shrinking and projected to end this parliament no bigger than it started—and high interest rates.2 Hunt, who was previously the NHS’s longest serving health secretary (from 2012 to 2018), told the country that “difficult decisions” were needed3 but provided some top-up funding for the NHS and social care.
Overall health spending will now grow by 1.2% a year in real terms over the next two years—less than in the decade before the pandemic (2% a year) and much less than the long term average (3.8%). Spending on the NHS will grow faster (2%) but still falls short of the growth needed to keep up with increasing demand for services and deliver pre-pandemic levels of care.4
Just how short the NHS will be depends on how you calculate what the service can buy with its extra cash. For example, last month NHS leaders estimated that the health service could face a shortfall of around £6bn-£7bn next year because of higher inflation and staff pay increases.5 The government has pledged only around half this amount and also wants the NHS to make efficiency savings of 2.2%—well above past efforts.6
The NHS will have to make its own difficult decisions. The waiting list for routine hospital treatment is now over 7 million,7 and emergency care is under extraordinary strain. So far this year, around 255 000 people have waited more than 12 hours on trolleys in emergency departments for a hospital bed—over three times more than in the past 10 years combined.8 Grim data on hospital care reflect pressures across the system: in general practice, community services, mental health—everywhere. Performance targets are being missed all year round. So where should the health service focus resources? NHS leaders must set clear priorities for services, and politicians should be honest about the consequences for patients.
The autumn statement also set out new NHS policy. The government will publish long term projections of the numbers of doctors, nurses, and other professionals needed in the NHS. This is welcome and could inform better planning. But projections will do little good without a long term strategy for recruiting and retaining staff, or the funding needed to deliver it. The NHS still has neither.
Hunt also announced a review of how the NHS’s new integrated care boards—area based agencies responsible for health system planning—can “work with appropriate accountability and autonomy.”1 These boards were established only in July 2022. Policy makers should avoid yet more structural changes and focus on what local teams need to improve services instead. More staff in the right places would help. Better alignment of NHS policy—like targets and payment systems—around the system’s objectives is needed too. But so are the basics such as modern buildings, equipment, and IT. Over the past decade, UK investment in healthcare capital as a share of GDP has been consistently lower than that in comparable countries.9
Prolonging public policy failure
Government also announced extra funding for social care—£2.8bn in 2023-24 and £4.7bn in 2024-25. More money is desperately needed: the system is on its knees, many people go without the care they need, and rates of poverty and deprivation among care workers are high.10 But it’s not clear how far the cash will go. Some will be eaten up by inflation, including increased energy costs for care providers, and some will depend on local authorities raising council tax. This could widen inequalities given that council tax is regressive11 and its revenue potential is inversely correlated with local care needs.12
The extra money has also been traded for planned reforms to England’s broken social care system. Government plans to cap people’s care costs and introduce a more generous means test were set to be implemented in 2023. But these have been pushed back to October 2025—after the next election—and councils will be able to use the money earmarked for reform to meet current pressures instead. Sound familiar? The same reforms were legislated for in 2014, then delayed, then abandoned. And broader reform proposals have been promised then ducked for decades. Government has chosen to prolong this public policy failure, leaving vulnerable people without protection against potentially catastrophiccare costs.
Standing back, the outlook for the nation’s health looks gloomy. Health is shaped by social and economic conditions, such as jobs and income.13 Yet real household disposable incomes are projected to fall by around 7% over the next two years2 and unemployment is set to rise. Beyond the NHS and other protected sectors, public services have been left to cope with rising inflation, which will affect what they can offer to the public and what they can pay staff.
A major spending squeeze has been pencilled in for after the next general election, when the state of the NHS and other public services will likely be on the ballot. Meantime, people will continue to feel the consequences of creaking public services in a nation getting poorer.
Footnotes
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.